According to the Centers for Disease Control and Prevention (CDC), an estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings. Amidst the astronomical opioid epidemic, it is imperative that one stays informed when considering treatment for chronic pain. This summer, the American Society of Anesthesiologists (ASA) released guidelines to help patients work with their doctor to find the best course of treatment and to understand the impact of opioid usage in their life.
Among ASA recommendations are the following questions to ask your doctor to help prevent an opioid addiction and overdose:
With these key questions in mind, it is also important to be aware that certain conditions increase opioid side effects and risk of overdose. According to another publication by the ASA, respiratory conditions, liver dysfunction, renal insufficiency, sleep apnea (both obstructive and central), cardiac disease, medication allergies, and other conditions should be assessed prior to administering opioid medication. With regards to potential drug interactions, co-morbidities, and other conditions that might predispose a patient to opioid overdoses, the ASA recommends:
“Benzodiazepines and other sedatives can increase the risk of side effects or adverse events when combined with opioids, particularly respiratory depression and/or aspiration. Both classes of medications have been implicated in the worsening of obstructive sleep apnea (OSA) and thus are relatively contraindicated with this condition due to suppression of the gag reflex and reduction of airway protection. Similarly, other illnesses that compromise respiratory function and oxygenation, such as COPD or pneumonia, may pose additional risks for patients taking opioids; this risk is particularly high with the addition of sedative/hypnotic medications such as benzodiazepines. All of these situations should be monitored while a patient is taking chronic opioids.”
Other risks for opioid addictions and overdoses include a history of addiction, overdose, or mental illness. The U.S. National Institutes of Health (NIH) explains, “there is considerable overlap between psychiatric disease and chronic pain syndromes; patients with depressive or anxiety disorders are at increased risk for overdose, as compared with patients without these conditions because they are more likely to receive higher doses of opioids. Such patients are also more likely to receive sedative hypnotic agents (e.g., benzodiazepines) that have been strongly associated with death from opioid overdose.”
Feldman Shepherd attorneys have represented families of patients who have died fro an opioid overdose while being treated for conditions such as sleep apnea, administered opioids, and not monitored properly. For instance, a recent case from Chester County, our 51-year-old client who died during an admission for workup of non-specific abdominal pain, was prescribed the potent opioid medication Diilaudid by his own primary care doctor, who not only knew of his history of obstructive sleep apnea and a previous near-miss involving the same medication but also failed to order the patient additional monitoring. Feldman Shepherd attorney and medical doctor Evan Y. Liu has written about prescription opioid deaths and related cases the firm has handled in his latest article, “Preventable Opioid Deaths in Hospitals: The Epidemic No-one is Talking About.”
Opioid use always poses significant health risks, however, staying informed can help mitigate these risks. Learn how your medical and mental health history can affect opioid use, and maintain an open dialogue with your doctor regarding opioid usage.